Pneumonia diagnosis performance in the emergency department: a mixed-methods study about clinicians’ experiences and exploration of individual differences and response to diagnostic performance feedback-Reference-Cited by-同舟云学术

Pneumonia diagnosis performance in the emergency department: a mixed-methods study about clinicians’ experiences and exploration of individual differences and response to diagnostic performance feedback

Published:2024-05-25 Issue:7 Volume:31 Page:1503-1513
ISSN:1067-5027
Container-title:Journal of the American Medical Informatics Association
language:en
Short-container-title:

Author:

Butler Jorie M¹²³⁴^ORCID,Taft Teresa¹^ORCID,Taber Peter¹³,Rutter Elizabeth⁵,Fix Megan⁵,Baker Alden⁶,Weir Charlene¹^ORCID,Nevers McKenna⁷,Classen David⁷,Cosby Karen⁸,Jones Makoto³⁷,Chapman Alec⁹^ORCID,Jones Barbara E³¹⁰^ORCID

Affiliation:

1. Department of Biomedical Informatics, University of Utah Spencer Fox Eccles School of Medicine , Salt Lake City, UT 84108, United States

2. Department of Internal Medicine, Division of Geriatrics, University of Utah Spencer Fox Eccles School of Medicine , Salt Lake City, UT 84132, United States

3. Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation , Salt Lake City, UT 84148, United States

4. Geriatrics Research, Education, and Clinical Center (GRECC), VA Salt Lake City Health Care System , Salt Lake City, UT 84148, United States

5. Department of Emergency Medicine, University of Utah Spencer Fox Eccles School of Medicine , Salt Lake City, UT 84108, United States

6. Department of Family and Preventive Medicine, Division of Physician Assistant Studies, University of Utah Spencer Fox Eccles School of Medicine , Salt Lake City, UT 84108, United States

7. Department of Internal Medicine, Division of Epidemiology, University of Utah Spencer Fox Eccles School of Medicine , Salt Lake City, UT 84108, United States

8. Department of Emergency Medicine, Cook County Hospital, Rush Medical College , Chicago, IL 60612, United States

9. Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine , Salt Lake City, UT 84108, United States

10. Department of Internal Medicine, Division of Pulmonology, University of Utah Spencer Fox Eccles School of Medicine , Salt Lake City, UT 84108, United States

Abstract

Abstract Objectives We sought to (1) characterize the process of diagnosing pneumonia in an emergency department (ED) and (2) examine clinician reactions to a clinician-facing diagnostic discordance feedback tool. Materials and Methods We designed a diagnostic feedback tool, using electronic health record data from ED clinicians’ patients to establish concordance or discordance between ED diagnosis, radiology reports, and hospital discharge diagnosis for pneumonia. We conducted semistructured interviews with 11 ED clinicians about pneumonia diagnosis and reactions to the feedback tool. We administered surveys measuring individual differences in mindset beliefs, comfort with feedback, and feedback tool usability. We qualitatively analyzed interview transcripts and descriptively analyzed survey data. Results Thematic results revealed: (1) the diagnostic process for pneumonia in the ED is characterized by diagnostic uncertainty and may be secondary to goals to treat and dispose the patient; (2) clinician diagnostic self-evaluation is a fragmented, inconsistent process of case review and follow-up that a feedback tool could fill; (3) the feedback tool was described favorably, with task and normative feedback harnessing clinician values of high-quality patient care and personal excellence; and (4) strong reactions to diagnostic feedback varied from implicit trust to profound skepticism about the validity of the concordance metric. Survey results suggested a relationship between clinicians’ individual differences in learning and failure beliefs, feedback experience, and usability ratings. Discussion and Conclusion Clinicians value feedback on pneumonia diagnoses. Our results highlight the importance of feedback about diagnostic performance and suggest directions for considering individual differences in feedback tool design and implementation.

Funder

Gordon and Betty Moore Foundation

Publisher

Oxford University Press (OUP)

Link

https://academic.oup.com/jamia/article-pdf/31/7/1503/58243687/ocae112.pdf

Reference78 articles.

1. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II;Leape;N Engl J Med,1991

2. Diagnostic Errors in the Emergency Department: A Systematic Review

3. A program to provide clinicians with feedback on their diagnostic performance in a learning health system;Meyer;Jt Comm J Qual Patient Saf,2021

4. Measurement is essential for improving diagnosis and reducing diagnostic error: a report from the Institute of Medicine;McGlynn;JAMA,2015